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General NPI Number Information
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NPI Number | 1730698622
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Entity Type | Organization
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Legal Business Name | HEALING WATERS WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 09/24/2017
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 9695 LEBANON RD STE 340
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City | MOUNT JULIET
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State | TN
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Zip | 37122-5541
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Country | US
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Telephone | 833-432-5987
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Fax |
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Provider Business Mailing Address
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Address Line | 5543 EDMONDSON PIKE STE 197
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City | NASHVILLE
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State | TN
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Zip | 37211-5808
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JANET PELMORE
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Credential |
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Telephone | 833-432-5987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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